Xerostomia

(Mouth-Dryness or Perceived Mouth-Dryness)

Xerostomia is rarely due to a nutrient deficiency, but may be seen in severe vitamin A deficiency and in protein calorie malnutrition. The primary causes of xerostomia include medications, Sjögren’s syndrome, diabetes mellitus, and head and neck radiation therapy. Altered taste sensations are frequently reported by individuals with xerostomia,

Xerostomia (perception of dry mouth) is the most frequently reported adverse effect of medication; but may not be actually be associated with definite reduced salivary flow. Medications such as anticholinergics, centrally acting antihypertensives, antihistamines, antipsychotics, narcotic analgesics, hypnotics, muscle relaxants, anticonvulsants, antineoplastics, cyclic antidepressants, and diuretics can decrease salivary secretion. Medication-induced xerostomia can change taste and cause chewing and swallowing difficulties leading to reduced food consumption, subclinical malnutrition, and decreased resistance to disease and stress, especially in the elderly. Decreased salivary flow can also lead to oral mucosal tenderness, inflammation, and ulcerations, making removable partial or full dentures less tolerable. Xerostomia can increase incidence and severity of candidiasis leading to increased pain, burning, and altered taste perception. Reduced salivary flow also leads to reduced enzymatic removal of dental plaque; diminished buffering capacity and acid neutralization increased food debris buildup, thus resulting in increased caries and periodontitis risk.

The major effects of xerostomia are increased oral diseases (particularly caries), speech dysfunction, difficulty in chewing and swallowing, and altered or diminished taste acuity. Nutritionally, individuals with xerostomia have significant deficiencies in fiber, potassium, vitamin B6, iron, calcium, and zinc. Treatments include the use of salivary substitutes and stimulants, ongoing dental treatment and prevention. Also, your physician may be able to substitute medications that have an anticholinergic effect.

Conventional treatments include the use of artificial saliva. However, they may also contribute to altered taste. Inadequate salivary flow can also contribute to oral infections, such as glossopyrosis.

Nutritional therapeutics includes moist, non-spicy foods, and temperate fluids; fluids are particularly important at mealtime. Oral hygiene is very important to reduce risk of dental caries, particularly following meals and snacks.


Dietary recommendations for xerostomia:

Use sugar-free candy, gum, and ice pops, and ice chips and frozen grapes. Persons with xerostomia should be encouraged to use tart or citrus flavored sugar-free gums and candies (xylitol-containing) in place of the sugared varieties to increase salivary flow. Xylitol-containing products help prevent dental caries and promote salivary flow. Soft foods are easier to swallow, such as custards, soups, ice cream, puddings, etc. Yogurt, cottage cheese, and bean soups are good protein sources. Soften food in liquids and cut food into small pieces adding gravy or sauces to make them easier to swallow. Drink water while eating. Papaya helps break up thick saliva.

The key determinants that influence oral and general health include:

  1. Individual biology and genetics
  2. The environment, including its physical and socioeconomic aspects
  3. Personal behaviors and lifestyle
  4. Access to care

The oral cavity is a portal of entry as well as the site of disease for microbial infections that affect general health status. Like skin, an intact oral mucosa is the first line of defense against the invasion of pathogens into the body.  Maintenance of an intact oral mucosa can be difficult because of constant exposure to bacteria and the high risk for trauma.